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The research, conducted by the Johns Hopkins Children's Center and All Children's Hospital in Florida, suggests that awareness alone is not enough to effect meaningful weight change, and that pediatricians should help parents with specific and tailored guidance on how to apply their knowledge in daily practice, the researchers said.

The study, published ahead of print on April 11 in the journal Clinical Pediatrics, also illuminates the gap between what parents know about the root causes of obesity and what they can actually do to maintain healthy diets for preschoolers, a group generally overlooked in obesity research and prevention.

"When it comes to obesity prevention, the focus tends to be on school-age children and teens, but a growing body of research has found a link between poor life-long health and being overweight as early as 2 years of age," said lead investigator Raquel Hernandez, M.D. M.P.H., a pediatrician at Johns Hopkins.

The Centers for Disease Control and Prevention define children with a body-mass index at or above the 85th percentile for their age as overweight. One-third of the 150 children in the current study were overweight, most from low-income urban homes, and more than 90 percent African-American.

"Childhood obesity is a complex, multi-factorial phenomenon but our findings reveal that, for the most part, lack of parental awareness of nutritional risk factors is not one of the drivers behind it," Hernandez said.

The investigators set out to identify parental perceptions of risk factors for childhood obesity and barriers to healthy weight and to determine whether the parents of healthy-weight preschoolers viewed such risks and barriers differently from the parents of overweight children. They didn't. The study found minimal to non-existent differences between the two groups.

One important risk factor remained seriously overlooked by parents in both groups: physical activity. Only 7 percent of parents in the healthy-weight group and 8 percent in the overweight group cited lack of physical activity as a top driver of unhealthy weight.

Recent studies have shown that few preschoolers achieve healthy levels of activity, and most remain sedentary 85 percent of the time, the investigators say. The results of the study suggest that parents undervalue physical activity in an age group often perceived as "active enough," and alerting parents to the risks of inactivity is critical in obesity prevention, according to Janet Serwint, M.D., of Johns Hopkins Children's Center.

"The importance of physical activity and age-appropriate exercise is one area where we could step up educational efforts," Serwint said. "Pediatricians should discuss specific and age-appropriate activity goals during well-child visits."

Nearly 40 percent of parents in both groups identified buying and preparing unhealthy food as the top contributor to weight problems at an early age. Similar numbers of parents in both groups (23 percent and 31 percent) cited using food as a reward for good behavior as a risk factor for weight problems. A nearly equal proportion of parents in both groups (25 percent and 23 percent) said that asking the child to finish food on the plate was the most critical contributor to overweight or obesity.

Importantly, one-third of parents from both groups (35 percent and 33 percent) identified lack of control over the child's food choices as the top barrier to healthy weight -- a notable finding, the researchers say, given that most preschool children spend most of their waking hours in daycare or with alternate caregivers.

"Daycare providers, grandparents and others involved in a child's care are often just as important in achieving healthy-weight goals as the parents themselves, and parents should be encouraged to provide specific dietary and activity instructions to these influential caregivers," Hernandez said.

Co-investigators on the study included Tina Cheng, M.D. M.P.H., and Darcy Thompson, M.D. M.P.H., both of Johns Hopkins.

The research was funded by The Thomas Wilson Sanitarium for Children of Baltimore City.

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